Monday, March 19, 2012

Dr. Carlat Goes to Washington To Head Pew Prescription Project

This will be my last Carlat Psychiatry Blog post for a while, as I have recently accepted a new job as the director of the Pew Prescription Project in Washington DC. My main job there will be to pull together a group of experts to review conflict of interest recommendations, and to work with various partner organizations (AMSA, Community Catalyst, and the National Physician's Alliance) to disseminate these recommendations to medical schools and teaching hospitals throughout the U.S.

Because my current job as owner of Carlat Publishing creates its own potential conflict of interest, I am in the process of relinquishing involvement in the company--hiring a new CEO, and placing any profits into an account which I can access only if and when I return to the company. Although I will continue to own Carlat Publishing, I will draw no salary from it, nor will I have any contact with the business in any way. I want to prevent any appearance that I'm joining Pew in order to increase my company's profits from non-industry-sponsored CME activities.

I thank all my devoted blog readers over the years, and I intend to continue writing and blogging about medical conflicts of interest issues and psychiatry--though not in the context of the Carlat "brand."

Strange choice. Dr. Balts has written about the transparency issue and about taking swag from drug reps... his views do not seem aligned with Dr. Carlat's views. This is an unfortunate turn of events for readers, though I congratulate Dr. Carlat.

Dr. Carlat, I applaud again your activities to bring truth to psychiatry.

However, conflict of interest is only one part of the problem. Yes, it underlies many, many bad studies that misrepresent the efficacy and safety of the drugs that are the bread and butter of psychiatric practice.

At this point, however, 20 years of corrupted information has a life of its own. Bad information leads to bad clinical practice. Bad clinical practice leads to patient harm.

Conflict of interest in psychiatry might be completely eliminated tomorrow and psychiatrists (as well as other doctors) would still be prescribing the same drugs and still disregarding adverse effects.

Corruption in psychiatry does not exist in a vacuum of uncouth appearances. It is sheer wishful thinking that the lack of real evidence in psychiatry's "evidence-based medicine" has not left its marks on the health of patients.

Aside from a stop to conflict of interest (you would think that ethics have yet to be invented), psychiatry desperately needs someone to find whatever real truths there are in that mass of so-called "evidence." Until then, the prescription of any psychiatric drug is not qualified by an adequate understanding of its risks.

It will be essential to include people in recovery on this committee. The biggest conflict of interest of all is that a person may come into a psychiatrists office experiencing trauma, grief, poor self-care or nutrition, a bad job fit, family problems, or other existential crises. Too often these get diagnosed and labeled as "illnesses." This can be a lifetime self-fulfilling prophecy with diagnoses that are harmful and medications with way too many iatrogenic effects.

Yet doctors are only trained to diagnose and medicate. If the only tool you have is a hammer, everything looks like a nail. This conflict of interest is the root cause of all the other conflits you are looking at. You will need to include peers on your committee to address it.

I just wrote a blog on 8 reason peer may know more about outcomes literature than many psychiatrists.http://wellnesswordworks.com/mental-health-outcomes/

It will be essential to include people in recovery on this committee. The biggest conflict of interest of all is that a person may come into a psychiatrists office experiencing trauma, grief, poor self-care or nutrition, a bad job fit, family problems, or other existential crises. Too often these get diagnosed and labeled as "illnesses." This can be a lifetime self-fulfilling prophecy with diagnoses that are harmful and medications with way too many iatrogenic effects.

Yet doctors are only trained to diagnose and medicate. If the only tool you have is a hammer, everything looks like a nail. This conflict of interest is the root cause of all the other conflits you are looking at. You will need to include peers on your committee to address it.

I just wrote a blog on 8 reason peer may know more about outcomes literature than many psychiatrists.http://wellnesswordworks.com/mental-health-outcomes/

That's mighty big of you to want to prevent the "appearance" of conflict of interest…why not just end your conflict of interest by dissolving your company? You're not going to take a salary, but you'll keep all the profits in a "lockbox" until you decide to quite your government job. Al Gore would be proud of you…play it cool while with the government and "lockbox" all your goodies until you get back to the private sector - then spring them free, divorce your wife, buy a mansion on the coast, get fat, grow a beard, and party like a rock star. What a hypocrite.

The Pew Prescription Project is a private organization that "seeks to ensure transparency in physician-industry relationships and promotes policies to reduce or manage conflicts of interest that could affect patient care. Our efforts have supported the creation of new policies at medical schools, professional medical associations, and have successfully supported state and federal disclosure laws" (www.pewhealth.org/projects/pew-prescription-project-85899367092).

Otherwise, I share Anonymous's (March 26, 2012 7:29 PM) concern. Why not dissolve your company to remove conflict of interest or appearance of conflict of interest with your position at the Pew Prescription Project?